Abstract
Background
Dens invaginatus is a dental anomaly that can predispose the tooth to pulp and periapical
pathology.
Case Description
Different endodontists treated 6 maxillary incisors with dens invaginatus associated
with apical periodontitis. Cone-beam computed tomography was used to help with diagnosis
and treatment planning in most patients. Four patients received diagnoses of Oehlers
type II dens invaginatus and the other 2 as type III. In some patients with type II,
the invagination had to be perforated to permit access to the apical part of the true
root canal. Both the true canal and the invagination (pseudocanal) were treated in
all cases using an antimicrobial regimen based on chemomechanical preparation with
sodium hypochlorite irrigation and supplementary disinfection approaches. Calcium
hydroxide medication was used in all but 1 case. The root canal and invagination were
often filled using thermoplasticized gutta-percha techniques, sometimes using an apical
plug with a bioceramic material in teeth with large apical openings. All treated patients
had favorable clinical and radiographic outcomes.
Practical Implications
Regardless of the complex anatomic variations, common strategic therapeutic approaches
were identified that might serve as recommendations for proper management of teeth
with dens invaginatus and apical periodontitis. These approaches include cone-beam
computed tomographic planning, aggressive disinfection using sodium hypochlorite ultrasonic
or sonic activation and calcium hydroxide intracanal medication, and thermoplasticized
gutta-percha obturation of both the root canal and invagination.
Key Words
Abbreviation Key:
CBCT (Cone-beam computed tomography), NaOCl (Sodium hypochlorite), NSET (Nonsurgical endodontic treatment), pc (Percussion), pp (Palpation), pst (Pulp sensitivity tests), PUI (Passive ultrasonic irrigation)
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Biography
Dr. Hernández is a member of the Endochat Research Group, Rio de Janeiro, Rio de Janeiro, Brazil, a PhD student, Postgraduate Program in Dentistry, University of Grande Rio, Rio de Janeiro, Rio de Janeiro, Brazil, and a professor, Department of Endodontics, Francisco Marroquín University, Guatemala City, Guatemala.
Biography
Dr. Pérez is a member of the Endochat Research Group, Rio de Janeiro, Rio de Janeiro, Brazil, a professor, Department of Endodontics, Rey Juan Carlos University, Madrid, Spain, and a professor, Clinical and Experimental Research Group in Materials for Dentistry and Tissue Engineering, Universidad Católica de Murcia, Murcia, Spain.
Biography
Dr. Baasch is a member of the Endochat Research Group, Rio de Janeiro, Rio de Janeiro, Brazil, a master’s student, Postgraduate Program in Dentistry, University of Grande Rio, Rio de Janeiro, Rio de Janeiro, Brazil, and a professor, Department of Endodontics, Santa María University, Caracas, Venezuela.
Biography
Dr. Brisson-Suárez is a member of the Endochat Research Group, Rio de Janeiro, Rio de Janeiro, Brazil, a master’s student, Postgraduate Program in Dentistry, University of Grande Rio, Rio de Janeiro, Rio de Janeiro, Brazil and a professor, Department of Endodontics, Santa María University, Caracas, Venezuela.
Biography
Dr. Sellera is a member of the Endochat Research Group, Rio de Janeiro, Rio de Janeiro, Brazil and a clinical endodontist in private practice, Santos, São Paulo, Brazil.
Biography
Dr. Ferrari is a member of the Endochat Research Group, Rio de Janeiro, Rio de Janeiro, Brazil and a professor, specialization course, Associação Paulista de Cirurgiões-Dentistas, Santo André, São Paulo, Brazil.
Biography
Dr. Alberdi is a member of the Endochat Research Group, Rio de Janeiro, Rio de Janeiro, Brazil, a professor, Department of Endodontics, Faculty of Health Sciences, Catholic University of Córdoba, Córdoba, Argentina, and a professor, National University of Northeast, Corrientes, Argentina.
Biography
Dr. Carreira is a member of the Endochat Research Group, Rio de Janeiro, Rio de Janeiro, Brazil and a professor, Department of Clinical Dentistry, University Center FIBRA-Integrated School Brazil Amazon, Belém, Pará, Brazil.
Biography
Dr. Gomes-Azevedo is a member of the Endochat Research Group, Rio de Janeiro, Rio de Janeiro, Brazil and a clinical endodontics in private practice, Monterrey, Mexico.
Biography
Dr. Alves is a professor, Postgraduate Program in Dentistry, University of Grande Rio, Rio de Janeiro, Rio de Janeiro, Brazil and a professor, Department of Dental Research, Faculty of Dentistry, Iguaçu University, Nova Iguaçu, Rio de Janeiro, Brazil.
Biography
Dr. Rôças is a member of the Endochat Research Group, Rio de Janeiro, Rio de Janeiro, Brazil, a professor, Postgraduate Program in Dentistry, University of Grande Rio, Rio de Janeiro, Rio de Janeiro, Brazil and professor, Department of Dental Research, Faculty of Dentistry, Iguaçu University, Nova Iguaçu, Rio de Janeiro, Brazil.
Biography
Dr. Siqueira is a member of the Endochat Research Group, Rio de Janeiro, Rio de Janeiro, Brazil, a professor, Postgraduate Program in Dentistry, University of Grande Rio, Rio de Janeiro, Rio de Janeiro, Brazil, and professor, Department of Dental Research, Faculty of Dentistry, Iguaçu University, Nova Iguaçu, Rio de Janeiro, Brazil.
Article Info
Publication History
Published online: February 17, 2022
Accepted:
October 11,
2021
Received in revised form:
September 28,
2021
Received:
April 29,
2021
Publication stage
In Press Corrected Proof
Footnotes
Disclosure. None of the authors reported any disclosures.
Identification
DOI: https://doi.org/10.1016/j.adaj.2021.10.009
Copyright
© 2021 American Dental Association. All rights reserved.
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